Post ablative defects in the maxilla can be extremely complex, involve all three dimensions and may result in significant morbidity. Rehabilitation may be difficult with either an obturator or surgical reconstruction with a free fibula, Iliac crest or scapula. This is a retrospective study looking at all patients with hemimaxillectomy defects reconstructed with scapular and rehabilitated with dental implants. The study period was January 2011 until January 2015, 42 patients had a free scapular flap, although only 20 were for reconstruction of the maxilla. Four flaps had to be removed and two did not receive any implants. The 14 patients received a total of 50 implants, of which 46 were placed into the transplanted scapula. Three patients needed bony augmentation prior to implant placement. Following treatment all patients showed normal function with good speech, mastication, swallowing and respiration. There was no loss of implants and all were functionally loaded. This is an excellent retrospective study. Traditionally a scapular tip graft has limited bone and placement of implants into this can be fraught with difficulties. However, it is notable that all these reconstructions were done secondarily, and the harvested bone graft was shaped extra-orally on a 3D model. Following that, implants were placed a year later. This paper highlights the need to plan the initial placement of the bone correctly to allow for implant placement later.
Reconstruction with scapular tip following hemimaxillectomy and rehabilitation with dental implants
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